Antibiotic Resistance

ANTIBIOTIC RESISTANCE

(The following is an excerpt from our upcoming book on antibiotic and bacterial disease)

When modern medical care isn’t available, many deaths would be prevented by the availability of antibiotics in your disaster medicine cabinet. Indeed, you should consider having a supply of these drugs in your storage if you believe a disaster may occur that takes away your access to modern medical care. If you use antibiotics for every minor ailment that comes along, however, you will run out very quickly and may contribute to an epidemic of antibiotic resistance caused by overuse.

Resistant organisms develop ways to deactivate or otherwise circumvent an antibiotic’s action. In the case of penicillin resistance, some bacteria began to produce a chemical that broke down the beta-lactam ring in the structure of penicillin family drugs (also called “beta-lactams”). This chemical, known as beta-lactamase, rendered the antibiotic ineffective.

Antibiotics are essential tools for success in long-term survival. Unfortunately, the government, the livestock industry, and some physicians have fostered widespread resistance to many of the standard drugs. Even patients themselves put pressure on their health providers for antibiotic prescriptions. The Centers for Disease Control and Prevention report that a significant percentage of people leave their doctor’s office with an antibiotic prescription that is of absolutely no use to treat their viral infection (or no infection at all)!

Antibiotic overuse is an epidemic: More than 2 million diagnosed cases of antibiotic resistance were reported in the United States in 2013, leading to 23,000 deaths and costing 30 billion dollars.

As of 2015, The Centers for Disease Control and Prevention had compiled a list of close to 20 bacteria that have shown a tendency towards antibiotic resistance. They include various organisms that cause severe diarrheal disease, respiratory issues, wound infections, and even sexually transmitted disease.

The CDC’s list:

Clostridium difficile

Carbapenem-resistant Enterobacteriaceae (CRE)

Drug-resistant Neisseria gonorrhoeae

Multidrug-resistant Acinetobacter

Drug-resistant Campylobacter

Fluconazole-resistant Candida

Extended spectrum β-lactamase producing Enterobacteriaceae (ESBLs)

Vancomycin-resistant Enterococcus (VRE)

Multidrug-resistant Pseudomonas aeruginosa

Drug-resistant Non-typhoidal Salmonella

Drug-resistant Salmonella typhi

Drug-resistant Shigella

Methicillin-resistant Staphylococcus aureus (MRSA)

Drug-resistant Streptococcus pneumoniae

Multidrug-resistant mycobacteria tuberculosis

Vancomycin-resistant Staphylococcus aureus (VRSA)

Erythromycin-resistant Group A Streptococcus

Clindamycin-resistant Group B Streptococcus

There have been no effective treatments identified for some of the above microbes, as in the case of multidrug-resistant Tuberculosis. Methicillin-Resistant Staph. Aureus (MRSA) was responsible for more deaths than AIDS in recent years.

Even when prescribed appropriately by the physician, the actions of some patients contribute to the resistance epidemic. Many times, people will feel better after taking the first two to three days of a seven to ten-day course of an antibiotic. They then stop, assuming all is well.

Indeed, most of the bacteria are dead, but some colonies may persist if you prematurely end the treatment. A stubborn one percent multiplies and becomes the vanguard for a stronger, more resistant infection.

We understand that, in a long-term scenario, you may be tempted to use an antibiotic for a shorter time to conserve your last few pills. In a true long-term disaster, where no chance of obtaining replacement medicine exists, it may leave you with some tough decisions. Just be aware that the best way of eliminating an infection is completing the full course of treatment.

Those entrusted with the health of family members after a disaster must serve as the medical quartermaster. Wisely dispensing the medications available will not only save lives but also conserve the precious and scarce supply that would be all you have if some major event occurs. You must walk a fine line between observant patient management (doing nothing) and aggressive management (doing everything).

The liberal use of antibiotics is a poor strategy for a few reasons:

Overuse can foster the spread of resistant bacteria. In the 2011 salmonella outbreak, millions of pounds of antibiotic-laden turkey meat were discarded after 100 people were sent to the hospital with severe diarrheal disease. The food industry is responsible for 80% of the antibiotic use in the U.S. This is not used to treat sick livestock, but to make healthy livestock grow faster and get to market sooner.

This doesn’t have to be the case. Some European countries, like Denmark, forbid the routine use of antibiotics in livestock without any apparent detriment to public health. Consider supporting farmers who raise antibiotic-free livestock; this will decrease the further development of resistant bacteria, and, thus, the antibiotics you have will be more effective.

Potential allergic reactions may occur that could lead to anaphylactic shock. Frequent exposure to antibiotics increases the likelihood of developing an allergy to one or more of them.

Many infections, including most respiratory infections, are viral; antibiotics are completely ineffective in treating them. The common cold, for example, is a viral illness. Antibiotics would be no more effective than chewing gum in eliminating it.

Lastly, being trigger-happy with antibiotics may make diagnosing an illness more difficult. If you give antibiotics before you’re sure what medical problem you’re actually dealing with, you might “mask” the condition. In other words, symptoms that would have helped you figure out what disease your patient has could temporarily disappear. This could cost you valuable time in determining the correct treatment.

Rehydration, rest, and symptomatic relief (for example, ibuprofen to relieve fever) may be the most appropriate first course of action for most infections. The body may eliminate the bacteria and its toxins without antibiotics, so consider the use of these drugs only for serious disease. The logic behind this recommendation is twofold:

1) Antibiotics have side-effects. You might give a drug for, say, an infectious diarrhea only to find that its main side effect is…diarrhea.

2) Unless you own a pharmaceutical company, you’ll have only a limited supply of medicine. In a disaster, replacing those drugs will be difficult or impossible, so you’ll want to use them only when absolutely necessary.

It should be noted that that the director of the CDC (Centers for Disease Control) has advocated an increased “stewardship” of veterinary antibiotics due to the epidemic of antibiotic resistance. Vigilance is required, and rightly so, to stop the epidemic of antibiotic resistance we’re seeing today. As a result, we can expect access to antibiotics to be curtailed in the future.

In January 2018, the government chose to eliminate availability of a number of veterinary antibiotics to the general public. This initiative was called the Veterinary Feed Directive, and eliminated access to a wide range of antibiotics unless prescribed by a veterinarian.

Fortunately, the antibiotic options mentioned in this book are made for the ornamental or pet industry and not for, as the Veterinary Feed Directive implies, food-producing livestock. None of these meds are used in any large-scale operation meant to bring food to the table.

This doesn’t mean that aquarium and avian antibiotics might not, one day, be removed from the market, at least without a veterinarian’s prescription. Whether this is something that is likely to happen is uncertain; how many people bring sick guppies or goldfish to veterinarians? Despite this, the wise individual who is concerned about the loss of modern medical care in a disaster might consider obtaining a supply for their “austere medicine cabinet” sooner than later. A reliable source can be found at store.doomandbloom.net.

The judicious use of antibiotics under close supervision is required to utilize their benefits without increasing their risks. In austere settings where modern care is unavailable, it will be tempting to use up whatever supply of antibiotics exist. Discourage family members from taking these drugs without first consulting the person medically responsible for the family’s or group’s health. In normal times, of course, seek the advice of a qualified medical professional.